AB0530 CARDIOVASCULAR RISK STATUS IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS: WHICH ALGORITHMS IS THE BEST?
Authors: T. Panafidina, T. Popkova, L. Kondrateva, Y. Gorbunova, E. Nasonov
Journal: Annals of the Rheumatic Diseases (2022)

Background Systemic lupus erythematosus (SLE) has been strongly linked to accelerated atherosclerosis and increased cardiovascular morbidity and mortality. Rheumatological guidelines recommend evaluating the cardiovascular (CV) risk status in SLE patients, for an early identification of patients at high risk to preventive strategies. Objectives The aim of our study to compare three algorithms for CV risk estimation, namely Framingham, ACC/AHA (American College of Cardiology/American Heart Association) and QRISK3, in a cohort of patients with SLE. Methods This cross-sectional study included 279pts (84% females, median aged 37[28-45]years (median [interquartile range 25%-75%])) with SLE according to SLICC/ACR 2012 criteria, attending a routine visit at our Clinic between February 2018 and February 2020. Traditional risk factors (TRF), ongoing therapies, comorbidities and SLE-specific evaluation were assessed. In those without previous myocardial infarction or stroke (n=254, 83% females, aged 36[27-44]years), Framingham, ACC/AHA and QRISK3 algorithms were then used to estimate the individual risk of developing a CV disease over the next 10 years. In accordance with the NICE (National Institute for Health and Care Excellence) guidelines high-risk was considered for Framingham scores ≥10%, for ACC/AHA - ≥7,5% and for QRISK3 scores - ≥10%. Results Patients eligible for CV risk estimation were 254 of 279 enrolled. The median disease duration was 10[4-17]years, SLEDAI 2K-4[2-10], SLICC/DI–1[0-2]score. Framingham index reported (at the age 20-79years, n=238) a median risk score of 1[1-5]%, according to this algorithm 54/238 patients (23%) were classified as high-risk. ACC/AHA index (at the age 40-79years, n=99) showed a median risk score of 2[1-8]%, with 30/99 (30%) at high-risk. QRISK3 revealed (at the age 25-84years, n=211) a median risk score of 7,5[3,5-14,4]%, making it possible to classify 85/211 (40%) at high CV risk. To the same algorithm, the median relative risk (the ratio of the absolute risk of SLE patients to the estimated risk score in an age-, sex- and ethnicity-matched healthy ideal population) was 9,2[4,1-20,3]. «QRISK3 healthy heart age» showed a median of 64[56-71]years. The use of the QRISK3 scale revealed a greater number of SLE patients with CV high-risk compared to the Framingham: 40% vs 23% of patients, p&lt;0,001. Conclusion QRISK3 classifies a greater number of SLE patients at high-risk of developing CV diseases over the next 10 years in comparison with classic algorithms as Framingham and ACC/AHA. According to QRISK3 score the absolute CV risk of SLE patients is 9 times higher than the CV risk of healthy individuals. The use of QRISK3 as a tool in the evaluation of SLE patients could lead to the early detection in a considerable part of high-risk CV diseases development individuals who would have otherwise been underestimated by the application of Framingham and ACC/AHA algorithms. Disclosure of Interests None declared